The Ananya program (ananya is a Sanskrit word meaning “unique” or “unlike others”) was created by the Bill & Melinda Gates Foundation (the foundation) to address some of the important family health challenges in Bihar, one of India’s most populous and poorest states. Ananya started as a five-year program (2011–2015) with the long-term goals of reducing maternal, newborn, and child mortality; fertility; and undernutrition rates in Bihar. To achieve these goals, the foundation is funding a synergistic set of complementary grants focused on improving the reach, coverage, and quality of family health services in two main areas: (1) essential reproductive, maternal, newborn, and child health services and (2) diagnosis and treatment of infectious diseases, including pneumonia, diarrhea, tuberculosis, and visceral leishmaniasis. Since its inception, the program has also expanded to include additional interventions that focus on improving sanitation in Bihar and on strengthening the system for health payments, including health-related incentives for households and incentives and payments for frontline health workers. [126 pages]